ROTTERDAM/ERBIL - Iraqi Kurdistan is a petri dish for bacteria that no longer react to antibiotics. Some main bacteria gathered from nine hospitals in five Kurdish towns have been found to be almost 90 percent multi-resistant. This means that people ill with this bacteria can no longer be treated.
“An alarm is needed, because it is a disaster,” says Delshad Maghdid, a researcher of Kurdish descent in the Dutch city of Rotterdam, who is working on the problem of multi-resistant bacteria at the urology department of the Erasmus Medical Centre (EMC).
“Even though in Holland we have little resistant bacteria -- only about five percent -- this is an important subject,” he says in a Skype interview. The EMC wants to prevent this number from growing, and wants to find new solutions to fight multi-resistance in bacteria.
To enable research, Maghdid’s department went to Iraqi Kurdistan to collect samples of bacteria related to infections of the urinal tract and skin. They found that the bacteria are up to 86 percent resistant to multiple antibiotics. That is a good base for research, but a disaster for Kurdistan, he explains.
“As a result, people die of an infection, that elsewhere can be treated well,” according to Maghdid, who has three Kurdish PhD students working with him on the project in Rotterdam. “And when these people travel abroad, they can pass this bacteria over to others,” he says.
The gravity of the situation has been accepted at conferences in Kurdistan, where Maghdid presented his results. He has to be in regular contact with the Ministry of Health, which agrees action is needed but cites financial shortages.
Maghdid says that the cause of the problem is the excessive use of antibiotics in Kurdistan, starting at infancy. “In Europe, we do not give babies antibiotics until they are a year old, to make sure their immune system is stimulated. But in Kurdistan small babies are already given injections.”
In response, spokesman Dr Khalis Kader at the Ministry of Health in the Kurdistan capital of Erbil, points out that this is not a matter for his ministry, as the hospitals are tied to scientific protocols.
He calls the problem of resistant bacteria one that doctors should be aware of. But at the same time, he points to the culture in Iraqi Kurdistan. “People will take drugs without prescription, sometimes on advice of some relative.” The ministry has contacted the Syndicate of Pharmacists on the issue.
Bacteria become resistant when the patient does not finish a cure, or when he is fed time and again the same antidote. The immune system has been put out of order, so it cannot take over.
Kurdish doctors tend to prescribe a large number of medicines, because people expect them to, Maghdid says. “They are merciless when prescribing superfluous antibiotics for a simple flu, or in too high a concentration. They know it is dangerous and unnecessary, but they want to earn money.”
Kader calls this a “malpractice” which the ministry has often discussed with doctors.
Young doctor Omar Sarsam, who is specializing in cardio-thoracic medicine and works in different hospitals in Erbil, says he faces the problem often. “The patient does not believe he can be cured without antibiotics and demands them.”
That is why mothers buy antibiotics for their babies, without consulting a doctor, he says. “Parents lack education. A woman gets pregnant without knowing anything about her body, she just does what other people do or tell her to do.”
He puts part of the blame with nurses that are allowed to open clinics. “They are even called doctors, and see as many as 60 patients a day. They prescribe loads of antibiotics.”
Maghdid calls for prevention, in order to form a new generation that does not carry the multiple resistance. “That will take 10 to 15 years, and starts with the babies.”
He asks for hospitals to set up prevention units and to educate their staff on preventing bacteria from spreading. “Now, doctors will examine a patient wearing gloves, but don’t change them when they go to the next one.”
He also points out that in Kurdistan doctors only work with three main strains of antibiotics, while the pharmaceutical industry has developed new ones for the more intelligent bacteria. “Doctors have to open up to knowledge from the West. We have professors who will come over for free to help change the system.”
Sarsam agrees that doctors in Kurdistan should become better educated. But he thinks it is even more important that the Ministry of Health prohibits the selling of antibiotics over the counter. “It is a crime to give it to people without a prescription. We need a law to prevent that.”
And even so, he warns, it will take time before people will stop demanding the drugs. “If it is prohibited in Kurdistan, they will go to Mosul to get it without prescription. To make the change, we need careful planning.”
